HSRS OMB Package 1 

## HIGH SCHOOL REFORM STUDY Thank you for your school’s participation in this online survey, which is critical to advancing important research on high schools. The High School Reform Study (HSRS) seeks to understand strategies to help prevent at

- risk students from dropping out. An at

- risk student is defined as a student who is likely to fail at school, specifically failing to achieve basic levels of proficiency in key subjects (e.g., m ath and English) and/or dropping out of school altogether. The study is being conducted by SRI International and its partner, RTI International, on behalf of the U.S. Department of Education and its High School Graduation Initiative (HSGI). HSGI provides g rant funds to states and school districts in support of dropout prevention and school reentry efforts. The survey asks you about policies and strategies at your school during the 2014

– 15 school year, and takes about 30 minutes to complete. Your participat ion is voluntary. **The data collected will be used to understand what services and supports are available to high school** 

–**age students, what services and supports are most prevalent across the country, and the nature of student participation in**  **these service s and supports.**  Information collected from school leaders like you will help shape efforts to improve the quality of the high school experience, especially for those students at risk for not graduating high school. To begin the survey, please use the Web l ink provided (_________________). You will be prompted to enter the study ID number and password listed below. If you encounter any technical difficulties in completing this survey, please contact XXXXXX at RTI International. Your STUDY ID: Your STUDY PASS WORD:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such a collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx

- xxxx. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving the interview, please write: U.S. Department of Education, Washington D.C. 20202

-4651. If you have comments or concerns regarding the status of your in dividual interview, write directly to: H igh School Reform Study (HSRS), Policy and Program Studies Service, Office of Planning, Evaluation and Policy Development, 400 Maryland Ave, SW, Washington, DC 20202.HSRS OMB Package 2



### Notes to the reviewer: 1) The “prevalence” questions in each section (e.g., “ In the 2014

- 15 school year, does your school have case managers?”) are asked of all respondents. Subsequent questions are not asked if the respondent does not have the program or service in his/her school. 2) There are directions to the programmer of the online survey about skip logic denoted in red text (e.g., If user responds “Yes” to Q1, ask Q2 through Q7 )

.HSRS OMB Package 3

**1. Which of the following most closely describes your job title?**  (Please select only one) {Only allow one selection} Principal Vice or assistant principal School counselor Program director or program lead Social worker Other (Please specify: ________________________)

**2. Including this year, how many years have you been in any**  **position or job in this school**  **?** (Please round up to the next year) {Only allow one selection} 1 to 5 6 to 10 11 to 15 More than 15 

# BackgroundHSRS OMB Package 4

**3. Which of the following best describes your school?**  (Please select only one) {Only allow one selection} A regular school (not including magnet or charter schools). A charter school (a school that in accordance with an enabling state statute, has been granted a charter exempting it from selected state or local rules and regulations). A special program school or magnet school (e.g., a science or math school, performing arts school, talented or gifted school, or a foreign language immersion school). A career, technical, or vocational school (A high school that uses a career-themed c urriculum in academic coursework. Designed to engage students who are not interested in a traditional program of study and to make classes more relevant to them. Includes magnet high schools with a career theme such as a science, technology, engineering, a nd mathematics (STEM) high school.) An alternative school (a school that offers a curriculum designed to provide nontraditional education to students; e.g., to students at risk of school failure or dropout in a traditional setting).

**4. What type of**  **degree does your school offer?** (Check all that apply) High school diploma GED or other high school equivalency Certificate of attendance Other (Please Specify:__________________) None of the aboveHSRS OMB Package 5

**5. In the 2014** **- 15 school year, does your school have case**  **managers (sometimes called adult advocates )?**  (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q5 , ask Q6 through Q 12 . Otherwise, skip to Q 13
. **6. What is the typical caseload for the**  **case managers in your school?** (Please select only one) {Only allow one selection} **1 to 10 students**  **11 to 15**

**students 16 to 20** 

**students More** 

**than 20 students** 

**7. How are case managers allocated to students?**  (Please select only one) {Only allow one selection}
Offered of all students (school

-wide) Offered to a subset of students Assigned to all students (school

-wide) Assigned to a subset of students If user responds “Subset of students,” ask Q8 & Q9 . Otherwise, skip to Q 10
. **8. On average, a**  **pproximately what proportion of students in your school**  **receives a case manager in the 2014**  **- 15**  **school year ?**  {Slide bar for 1% to 100%}



# Case Manager An adult broker of different services to meet individual students’ needs, including academic, social, health, and financial (e.g., case management model, intrusive advising).HSRS OMB Package 6

**9. Are any of the following subset(s) of**  **students targeted for receiving a case manager?**  (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Reentry students English Language Learners Other (Please Specify________________)

**10. Typically, which**  **of the following qualifications do the case managers in your**  **school have? Required**  **to have Sometimes** 

**have Never** 

**have Don’t** 

**know**
Licensed in a mental health field (e.g., social work) Licensed in a physical health field (e.g., nursing) Law degree Paralegal degree High school counselor Certified teacher or certified support staff Other (Please specify: _______________)

**11. Do the case managers in your school**  **provide their services at your school**  **location? Always**  **Sometimes Never**  **Don’t know** HSRS OMB Package 7

**12. Do the case managers typically fill any**  **other roles or duties at your school? Always**  **Sometimes Never**  **Don’t know**  Teaching duties Administrative duties Social work duties School nurse or medical duties Guidance counselor Mental health counselor or psychologistHSRS OMB Package 8

**13. In the 2014** **- 15 school year, does your school have formal adult**  **mentor(s)?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q 13 , ask Q 15 through Q22 . Otherwise, skip to Q23
. **14. How are formal adult mentor(s) allocated to students?**  (Please select only one) {Only allow one selection} Offered of all students (school

-wide) Offered to a subset of students Assigned to all students (school

-wide) Assigned to a subset of students If user responds “Subset of students” to Q 14 , ask Q 15 & Q 16 . Otherwise, skip to Q 17
. **15. On average, a**  **pproximately what proportion of students in your school receives an adult mentor**  **in the 2014**  **- 15 school year**  **?** {Slide bar for 1% to 100%}



# Adult Mentoring An adult assigned to student(s) to ensure that they stay on track academically, help raise students’ educational goals, and offer a sounding board for personal concerns. Not a case manager or regular school counselor.HSRS OMB Package 9

**16. Are any of the following subset(s) of students targeted for receiving an**  **adult mentor?** (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Reentry students English Language Learners Other (Please Specify________________)

**17. Who serves as formal adult mentor(s) in your school?**  (Check all that apply) Teachers School counselors Administrative staff Other school staff Community volunteers Community

- based agency staff District

- employed staff whose job is to mentor students College student Other (Please specify: __________________)HSRS OMB Package 10

**18. For what purpose do you assign formal adult mentor(s) in your**  **school?** (Check all that apply)
To ensure that students stay on track academically To provide advice about postsecondary options To help raise students’ educational or career goals To serve as a sounding board for personal concerns To improve student engagement in school To prevent at

- risk behavior To model positive and respectful behavior To develop conflict resolution skills To monitor attendance To help select classes To address family issues or concerns To explore community resources to address individual needs Other (Please Specify________________)

**19. What information do you use to match students with their**  **particular adult mentor?** (Check all that apply)

Academic record Discipline record Teacher recommendation Other adult recommendation Student selection of mentor Convenience (e.g., time, geography) Other (Please Specify________________)

**20. Are students**  **required to meet with their formal adult mentor?**  (Please select only one) {Only allow one selection}

Yes NoHSRS OMB Package 11

**21. On average, how often do students meet with their formal adult**  **mentor?** (Please select only one) {Only allow one selection}
Daily Weekly Every other week Monthly Less than monthly I don’t know

**22. On average, how many students share the same formal adult**  **mentor?** (Please select only one) {Only allow one selection}

1 student 2 to 5 students 6 to 10 students More than 10 studentsHSRS OMB Package 12

**23. In the 2014** **- 15 school year, did your school make formal**  **referrals for any of your student s to**  **outside agencies to address**  **individual student needs?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q23 , ask Q24 through Q28 . Otherwise, skip to Q29
. **24. To what type of social services does your school most often**  **refer students?** (Check all that apply) Health services Mental health services (e.g., anger management, communication, fostering healthy relationships, individual and/or family counseling) Child care for teen parents Engaging parents/families to u nderstand the academic, career, and/or personal needs of the student Providing resources to increase parent/family awareness of best practices in monitoring academic progress Immigrant/new arrivals services Addressing material needs (e.g., transportation, shelter, clothing) Other (Please specify: ________________________________)



# Access to Social Services Access to health, mental health, child care, and other social services. These services may be provided by the school, or schools may refer students and families to outside agencies.HSRS OMB Package 13

**25. To whom do you refer students for social services?**  (Check all that apply) Nonprofit community

- based organizations (CBOs) Religious/church organization (e.g., Catholic Charities) Community mental health agency Public health agency Juvenile justice agency Social services agency Local business or other for

- profit organization Other (Please specify _____________)

**26. On average, a**  **pproximately what proportion of students in your school has been referred to**  **outside agencies**  **for social services in the 2014**  **- 15 school year**  **?** {Slide bar for 1% to 100%}

**27. Are you informed about whether referrals result in action taken**  **for the student at the outside agency?**  (Please select only one) {Only allow one selection} **Yes No** 

If user responds “No” to Q27 , ask Q28 **28. From your perspective, do referrals typically result**  **in action taken by an outside agency?**  (Please select only one) {Only allow one selection} **Yes No** HSRS OMB Package 14

**29. Does**  **your school offer any of the following services on**  **- site?**  (Check all that apply) Health services Mental health services (e.g., anger management, communication, fostering healthy relationships, family counseling) Child care for teen parents Engaging parents/families to u nderstand the academic, career, and/or personal needs of the student Providing resources to increase parent/family awareness of best practices in monitoring academic progress Immigrant/new arrivals services Addressing material needs (e.g., transportation, shelter, clothing) Other (Please Specify:_____________________)

**30. On average, a**  **pproximately what proportion of students receives social services**  **in your school in the**  **2014 -**  **15 school year ?**  {Slide bar for 1% to 100%}HSRS OMB Package 15

**31. In the 2014** **- 15 school year, did your school have any formal**  **positive school climate p rograms?**  (Please select only one) {Only allow one selection} **Yes No** 

If user responds “Yes” to Q31 , ask Q32 & 33 . Otherwise, skip to Q34
.
**32. In the 2014** **- 15 school year, does your school have any of the**  **following positive school climate approaches?**  (Check all that apply)
High expectations for behavior Goals for promoting a positive school climate and prosocial behavior Clear, developmentally appropriate and proportional consequences for inappropriate behavior Incentives and recognition for successful behavior Conflict

- resolution strategies and skills In

- school suspension (to provide oversight and instruction to students during their suspension period) Other (Please Specify:__________________________) 

# Positive School Climate Programs An intentional and structured approach to promoting a positive school climate and prosocial behavior. Most approaches include clear behavior expectations, incentives and recognition for success, and skilled conflict

- resolution processes.HSRS OMB Package 16

**33. Are any of the following subset(s) of students targeted for receiving**  **positive school climate approaches?** (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Reentry students English Language Learners Other (Please Specify________________)HSRS OMB Package 17

**34. In the 2014** **- 15 school year, does your school have credit**  **- recovery**  **courses or programs?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q34 , ask Q35 through Q42 . Otherwise, skip to Q 43
. **35. Are any of the following subset(s) of students targeted for receiving**  **credit -**  **recovery courses or programs?** (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Re

- entry students English Language Learners Other (Please Specify________________)

**36. On average, a**  **pproximately what proportion of students in your school is offered credit**  **- recovery**  **courses or programs in the 2014**  **- 15 school year**  **?** {Slide bar for 1% to 100%}

**37. How are credit**  **- recovery courses offered?**  Please select only one. {Only allow one selection} Online In person Blended learning (e.g., online with an in

- person facilitator) 

# Credit Recovery Credit

- bearing courses to help students make up failed classes and keep them on track for graduation.HSRS OMB Package 18

**38. Where are credit**  **- recovery courses offered?**  (Check all that apply) At your school (including computer or resource lab) In the students’ homes {Load only if “Online” Or “Blended Learning” was selected in Q37 } At another school At another location (e.g., reengagement center) (Please specify: ___________)

**39. When are credit**  **- recovery courses offered to your students?**  (Check all that apply) During the summer During the regular school day Before and/or after school during the week On weekends during the school year (e.g., Saturday school)

**40. Who provides instruction in credit**  **- recovery courses in your school?**  (Check all that apply) Teacher provided by the online course provider {Load only if the user selects “Online” in Q37 } Classroom teachers Resource lab teachers Paid tutors hired by the school Unpaid tutors hired by the school Tutors hired by an outside organization Adult mentors Other school staff (e.g., administrators, paraprofessionals) Other (Please specify __________________)

**41. On average, a**  **pproximately what proportion of students in your school is participating in credit**  **recovery at any location in the 2014 -**  **15 school year?** {Slide bar for 1% to 100%}HSRS OMB Package 19

**42. On average, approximately how many students per teacher are there in each credit**  **** **recovery class in your school?** (Please select only one) {Only allow one selection} 1 to 5 students 6 to 10 students 11 to 15 students 16 to 20 students 21 to 25 students 26 to 30 students More than 30 studentsHSRS OMB Package 20

**43. In the 2014** **- 15 school year, does your school**  **have accelerated academic programs?**  (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q 43 , ask Q44 through Q52 . Otherwise, skip to Q53
. **44. Are accelerated academic programs offered to all students**  **(school -** **wide) or to a specific subset of students?**  Please select only one. {Only allow one selection} **All students (school**  **- wide)**  **Subset of**

**students**
If user responds “Subset of students” to Q 44 , ask Q 45 & Q 46
. **45. On Average, a**  **pproximately what proportion of students in your school is offered**  **a n accelerated**  **academic program in the 2014**  **- 15 school year**  **?** {Slide bar for 1% to 100%}

**46. Are any of the following subset(s) of students targeted for receiving**  **accelerated academic programs?**  (Check all that apply) Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Re

- entry students English Language Learners Other (Please Specify________________) 

# Accelerated Academic Programs Programs to provide students with the opportunity to experience a postsecondary course or earn college credits while in high school (e.g., Early/Middle College, Advanced Placement [AP], International Baccalaureate [IB], dual enrollment, Cambridge/Advanced International Certificate of Education [AICE]).HSRS OMB Package 21

**47. How are accelerated academic programs delivered to your**  **students?** (Please select only one) {Only allow one selection} Online As a classroom course Blended learning (e.g., online with an in

- person facilitator)

**48. Where are accelerated academic programs offered?**  (Check all that apply) At your school At another high school On a college campus In the students’ homes {Load this option only if the user selects “Online” in Q47 } At another location (Please specify: ___________)

**49. Who leads or facilitates the accelerated academic programs**  **delivered to your students?** (Check all that apply) A high school teacher, including those certified or hired as a college adjunct A college professor A teacher provided by the online course provider {Load only if the user selects “Online” in Q47 } Other (Please Specify________________) Don’t knowHSRS OMB Package 22

**50. Are any of the following required for at**  **- risk students to participate**  **in these accelerated courses?** (Check all that apply)

Teacher recommendation School administrator or guidance/school counselor approval Grade level (e.g., only juniors or seniors may enroll) Minimum GPA Satisfactory attendance record Minimum score on a standardized test or college placement exam (e.g., state test, SAT or ACT) Parent involvement (e.g., parent contract) Other (Please Specify________________)

**51. Do you provide any of the following supports to facilitate the**  **enrollment and persistence of at -**  **risk students in these courses?** (Check all that apply)

Adult mentors Peer mentors Credit recovery Tutoring Academic support classes Additional counseling Other (Please Specify________________)HSRS OMB Package 23

**52. What form of advanced coursework is offered to at**  **- risk**  **students?** (Check all that apply)
Advanced placement (AP) courses for college credit International Baccalaureate (IB), an international curriculum certified by the International Baccalaureate Organizations Early college or middle college program (combining high school and college coursework to compress the time it takes to earn both a high school diploma and the first two years of college, and/or an associate’s degree) Dual high school and college enrollment classes (students earn both high school and college credit) Advancement Via Individual Determination (AVID) classes Other (Please Specify________________)HSRS OMB Package 24

**53. In the**  **2014 -**  **15 school year, does your school offer academic support classes?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q53 , ask Q54 through Q60 . Otherwise, skip to Q61
. **54. How are academic support classes allocated to students?**  Please select only one. {Only allow one selection} Offered of all students (school

-wide) Offered to a subset of students Assigned to all students (school

-wide) Assigned to a subset of students If user responds “Subset of students” to Q54 , ask Q55 & Q56 . Otherwise, skip to Q57
. **55. Are any of**  **the following subset(s) of students targeted for receiving academic support classes?**  (Check all that apply) Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Reentry students English Language Learners Other (Please Specify________________)



# Academic Support Classes High school credit

- bearing classes designed to support students in their required core academic classes, such as algebra, by providing additional instructional time (e.g., double

- dose instruction). Part of a students’ regular schedule of classes; different from academic tutoring.HSRS OMB Package 25

**56. On average, a**  **pproximately what proportion of students in your school**  **is participa**  **ting in academic support classes in the 2014** **- 15 school year**  **?** {Slide bar for 1% to 100%}

**57. When are the academic support classes in**  **your school typically taught?**  (Please select only one) {Only allow one selection}
Same day, right before or after the regular core course Same day, but not right before or after the regular core course A different day in the same semester In a different semester **58. Who typically teaches the academic support classes in your school?**  (Check all that apply) The student’s regular core course teacher (e.g., English, math, science) Another regular core course teacher A special education classroom or pull

- out teacher (also teaches students outside of support classes) A teacher who only teaches support courses (does not have any other teaching duties) A tutor (unlicensed educator) Other (Please specify_________________)

**59. What curriculum is used in academic support classes in your school?**  (Please select only one) {Only allow one selection} The same curriculum used in the regular core course A support curriculum or materials aligned with the regular core course A support curriculum or materials not aligned with the regular core course There is no curriculum Other (Please specify_________________)HSRS OMB Package 26

**60. How are academic support classes**  **delivered?** (Please select only one) {Only allow one selection} Online In person Blended learning (e.g., online with an in

- person facilitator)HSRS OMB Package 27

**61. In the 2014** **- 15 school year, does your school have**  **mandated academic tutoring?**  (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q61 , ask Q62 through Q70 . Otherwise, skip to Q71
. **62. Are any of the following subset(s) of students targeted for mandated**  **tutoring?** (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Re

- entry students English Language Learners Other (Please Specify________________)

**63. On average, a**  **pproximately what proportion of students in your school is participating in academic**  **tutoring in the 2014**  **- 15 school year**  **?** {Slide bar for 1% to 100%}

**64. Who provides the academic tutoring in your school?**  (Check all that apply) A teacher licensed in a core academic subject A teacher licensed in a noncore subject A licensed special education teacher A professional tutor An unlicensed educator Other (Please specify_________________)



# Academic Tutoring Mandated tutoring for students who have fallen behind academically.HSRS OMB Package 28

**65. Who pays the academic tutors in your school?**  (Check all that apply) Tutors are paid by the school/district budget Tutors are paid by an outside organization Tutors are unpaid Other (Please specify __________________)

**66. Do the individuals who provide mandated tutoring in your**  **school also teach other classes?** (Please select only one) {Only allow one selection} Tutors do not have other teaching duties in my school Tutors also teach core academic subject classes (e.g., mathematics, English, science) Tutors also teach noncore subject classes (e.g., art, music) Tutors also teach special education students

**67. How is tutoring delivered?**  (Please select only one) {Only allow one selection} Online In person Blended learning (e.g., online with an in

- person facilitator)

**68. Is tutoring offered one**  **- on**  **- one or in groups?**  (Please select only one) {Only allow one selection} One

- on - one In small groups (10 or fewer students) In large groups (more than 10 students)HSRS OMB Package 29

**69. When is tutoring typically offered to your students?**  (Please select only one) {Only allow one selection} Before school After school During the school day (e.g., lunch, study hall) On the weekend

**70. What is the relationship between**  **mandatory tutoring and classroom instruction?**  (Check all that apply) Tutors use similar materials as the classroom teacher to provide additional instructional time Tutors use supplemental materials aligned with the regular core course Tutors use supplemental materials NOT aligned with the regular core course Tutors answer questions and hold study sessions for upcoming tests Tutors provide homework assistance Other (Please specify _____________)HSRS OMB Package 30

**71. In the 2014** **- 15 school year, does your school have student support teams?**  (Please select only one) {Only allow one selection} **Yes No** 
If the user responds “Yes” to Q71 , ask Q72 through Q77 . Otherwise, skip to Q78
. **72. Are any of the following subset(s) of students targeted for receiving a**  **student support team?** (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Reentry students English Language Learners Other (Please Specify________________)

**73. On**  **average , a**  **pproximately what proportion of**  **students in your school has a student support team in**  **the 2014 -**  **15 school year ?**  {Slide bar for 1% to 100%}

**74. Does your school have more than one student support team?**  Please select only one. {Only allow one selection} **Yes No** 



# Student Support Teams A team of staff to support students who exhibit behavior or performance problems

— an academic and/or behavioral intervention used to provide early, systematic assistance to students who are having difficulty in school (may be offered in a multitiered system of supports).HSRS OMB Package 31

If the user responds “Yes” to Q74 , ask Q75 through Q77 . Otherwise, skip to Q78
. **75. How are your student support teams organized?**  (Check all that apply) By grade level Across grades By type of student need (e.g., behavior versus academic problem) By type of academic or behavioral intervention Convenience Other (Please specify: ____________________)

**76. Who is included on student support teams?**  (Check all that apply) Regular classroom teachers Special education teachers Intervention specialists (not a classroom or special education teacher) Instructional coaches School counselors School psychologists School administrators Social workers School nurse Other (Please specify: ____________________)

**77. What services do the student support teams provide?**  (Check all that apply) Implement increasing tiers of school

- based intervention services Develop student intervention plans Monitor student progress Referrals to intervention services (e.g., reading or math specialist, counseling, intensive case management) Other (Please specify: ____________________)HSRS OMB Package 32

**78. In the 2014** **- 15 school year, does your**  **school have an early warning system?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q78 , ask Q79 through Q85 . Otherwise, skip to Q87
. **79. Is your early warning system used with any of the following grades?**  (Check all that apply) Before 9th grade 9th grade 10th grade 11th grade 12th grade

**80. Are any of these data collected in your early warning system?**  (Check all that apply) State achievement test scores Attendance Truancy and/or chronic absenteeism Course grades Discipline incidents including suspensions or expulsions Involvement with criminal justice system Involvement with social services or foster care Pregnancy/teen parenthood Reports of substance abuse Homelessness or frequent address change Limited English proficiency Migrant status Students overage for their grade level Students who are behind in accumulating credits for their grade level Other (Please specify __________________)



# Early Warning System Systems based on student

- level data to detect students who exhibit behavior or academic performance issues that put them at risk of educational failure.HSRS OMB Package 33

**81. Which of the following data trigger an intervention in your early warning**  **system?** (Check all that apply) {Carry forward only those the user checked in Q80 } State achievement test scores Attendance Truancy and/or chronic absenteeism Course grades Discipline incidents including suspensions or expulsions Involvement with criminal justice system Involvement with social services or foster care Pregnancy/teen parenthood Substance abuse Homelessness or frequent address change Limited English proficiency Migrant status Students overage for their grade level Students who are behind in accumulating credits for their grade level Other (Please specify __________________)HSRS OMB Package 34

**82. What action is taken if a student is flagged by an early warning system?**  (Check all that apply)
Meet with teachers and administrators Meet with parents Develop an intervention plan Assign an adult advocate or case manager {Ask only if the user replied “Yes” to Q5 } Assign an adult mentor {Ask only if the user replied “Yes” to Q 13 } Arrange access to social services {Ask only if the user replied “Yes” to Q23 } Mandate positive climate and discipline programs {Ask only if the user replied “Yes” to Q32 } Assign to credit recovery courses {Ask only if the user replied “Yes” to Q34 } Assign to double dose or academic support courses {Ask only if the user replied “Yes” to Q53 } Assign to mandatory tutoring {Ask only if the user replied “Yes” to Q61 } Refer to student support team {Ask only if the user replied “Yes” to Q71 } Other (Please specify __________________)

**83. Who has access to the data from early warning systems?**  (Check all that apply) Students Teachers School administrators District administrators Guidance/school counselors Adult advocates/case managers {Ask only if the user replied “Yes” to Q5 } Adult mentors {Ask only if the user replied “Yes” to Q 13 } Student support team {Ask only if the user replied “Yes” to Q71 } Other (Please specify __________________)HSRS OMB Package 35

**84. Who is primarily responsible for monitoring**  **the early warning systems?** (Please select only one) {Only allow one selection} {Carry forward only those the user checked “Yes” on in Q83 } Teachers School administrators District administrators Guidance/school counselors Adult advocates/case managers Adult mentors Student support team Other (Please specify __________________)

**85. To what extent do you agree that the data in your early warning systems is:**  **Strongly agree**  **Agree Disagree**  **Strongly disagree**  Routinely accessible to those who need it Easily interpreted Accurate Linked to ongoing intervention tracking and progress monitoringHSRS OMB Package 36

**86. In the 2014** **- 15 school year, does your school have any middle to high school**  **transition activities (past or planned)?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q86 , ask Q87 through Q90 . Otherwise, skip to Q91
. **87. In the 2014** **- 15 school year, does your school have any of the following**  **middle to high school transition activities (past or planned)?** (Check all that apply) Summer bridge program for incoming 9th graders (more than a one

- day orientation) Freshman academy (students housed together as a smaller unit within the high school campus with an assigned group of teachers) Support team that monitors 9th

- grade student progress and provides interventions A student mentor assigned to specific high

- risk students A student mentor assigned to all incoming 9th

- grade students An adult mentor assigned to specific high

- risk students An adult mentor assigned to all incoming 9th

- grade students A year

- long advisory class to provide information and support to succeed in high school (e.g., lessons on organizational and study skills or graduation requirements) Teaching parents strategies to help their child make the transition to high school (e. g., graduation requirements, strategies for academic success) Develop an individual high school graduation plan Other (Please specify ____________________) 

# Middle to High School Transition Planned activities to ease the transition from middle to high school, such as special outreach and transition programs (e.g., summer bridge program, freshman academy)HSRS OMB Package 37

**88. How are middle to high school transition activities allocated to**  **students entering high school?** (Please select only one) {Only allow one selection} Offered of all students (school

-wide) Offered to a subset of students Assigned to all students (school

-wide) Assigned to a subset of students If user responds “Subset of students” to Q88 , ask Q89 & Q90 . Otherwise, skip to Q91
. **89. On average, a**  **pproximately what proportion of students in your school participates**  **in middle to high school transition activities**  **in the 2014 -**  **15 school year**  **?** {Slide bar for 1% to 100%}

**90. Are any of the following subset(s) of students targeted for receiving**  **middle to high school transition activities?** (Check all that apply) Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Re

- entry students English Language Learners Other (Please Specify________________)HSRS OMB Package 38

**91. In the 2014** **- 15 school year, does your school have any flexible scheduling**  **alternatives?** (Please select only one) {Only allow one selection} **Yes No** 
If user selects “Yes” to Q91 , ask Q92 . Otherwise, skip to Q98
. **92. In the 2014** **- 15 school year, does your school have any of the following**  **flexible scheduling alternatives?** (Check all that apply)

a. Block scheduling (all classes scheduled for longer class periods or extended blocks of instructional time) b. Flexible block scheduling (some classes scheduled for longer class periods) c. Flexible start and end times (same length of day) d. Expanded school day (excluding evening classes) e. Shortened school day f. Year

- round schooling with same number of school days g. Additional school days in the year (excluding Saturday classes) h. Shortened week (e.g., 4

- day week) i. Saturday classes j. Evening classes k. Students working at their own pace using technology / online courses l. Other (Please specify ____________________)

If user checks items i , j , or k in Q92 , cycle through Q93 through Q96 for each option. **93. Are {Saturday classes}{Evening classes}{Online courses}**  **offered on -**  **site at your school location or off -**  **site?** (Please select only one) {Only allow one selection} **On -**  **site Off** **- site** 



# Flexible Scheduling Options that provide flexible and/or extended time for instruction or teacher/staff planning such as block scheduling, expanded school day, and alternative schedules.HSRS OMB Package 39

**94. How are**  **{Saturday classes}{Evening classes}{Online courses} allocated to students?**  (Please select only one) {Only allow one selection} Offered of all students (school

-wide) Offered to a subset of students Assigned to all students (school

-wide) Assigned to a subset of students If user responds “Subset of students” to Q94 , ask Q95 & Q96 . Otherwise, skip to Q98
. **95. On average, a**  **pproximately what proportion of students in your school participates in {Saturday**  **classes}{Evening classes}{Online courses}?** {Slide bar for 1% to 100%}

**96. Are any of the following subset(s) of**  **students targeted for {Saturday classes}{Evening classes}{Online courses}?**  (Check all that apply)
Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Re

- entry students English Language Learners Other (Please Specify________________)HSRS OMB Package 40

**97. In the 2014** **- 15 school year, does your school have any smaller learning**  **communities?** (Please select only one) {Only allow one selection} **Yes No** 
If user responds “Yes” to Q97, ask Q98. Otherwise, skip to Q99.

**98. In the 2014** **- 15 school year, does your school have any of the following types of**  **smaller learning communities?** (Check all that apply) Grade

- level academies (e.g., Freshman academy) Career

-themed academies and pathways School

-within

- a - school (e.g., a co

- located smaller school with its own program, staff and students) Other (Please specify ____________________) 

# Smaller Learning Communities Large comprehensive high school is broken into smaller units with the explicit goal of improving teacher

- student relationships, ensuring teachers know every student, creating a more personal and manageable environment for students to navigate.HSRS OMB Package 41

**99. In the 2014** **- 15 school year, how would you describe the coordination of different strategies**  **used in your high school?** {Load only the strategies users selected as occurring in their schools}
**Frequently coordinated**  **Sometimes**

**coordinated Rarely** 

**coordinated Not at all** 

**coordinated** Case manager {depends on Q5 } Adult mentoring {depends on Q 13 } Access to social services {depends on Q23 } Positive school cl imate programs {depends on Q31} Credit recovery {depends on Q34 } Accelerated academic programs {depends on Q 43 } Academic support classes {depends on Q53 } Academic tutoring {depends on Q61 } Early warning systems {depends on Q78 } Student support teams {depends on Q71 } Middle to high school transition programs {depends on Q86} Flexible scheduling {depends on Q91} Smaller learning communities {depends on Q97} 

# Coordination of Strategies School services provided to address the needs of students at risk of educational failure may be coordinated with one or more other strategies, or they may be isolated. Coordinated services are designed to work together in an integrated system to match students to appropriate resources. Isolated services operate independentl y, with little communication with other programs or services.HSRS OMB Package 42

**100. For the 2014**  **- 15 school year, does your school have any of the following?**  **Yes No**  **a. Instruction in academic readiness skills**  Instruction to help students develop behaviors and attitudes that support academic performance, including organizational skills, note

-taking techniques, time management, persistence with difficult tasks, goal setting, student collaboration (e.g., skills taught in programs like Advancement Via Individual De termination [AVID]). **b. Instruction in cognitive strategies**  Explicit instruction to develop key cognitive strategies important for academic success such as formulating problems, conducting research, interpreting conflicting evidence, communicating conclusions and findings, completing all work with accuracy.

**c. Career awareness or exploration activities**  Activities designed to build awareness of the variety of careers available by exploring career options and to assist students in beginning to iden tify areas of interest with the goal of motivating students and informing their decision

- making about careers and course selection for such careers. **d. Work** **- based learning**  An educational strategy to provide a range of experiences that are intentionally designed to help students extend and deepen classroom work, such as cooperative education programs, internships, and work study in which students earn course credits.

**e. Advisory systems**  A system to provide a structure and set of practices for monitoring and supporting students’ academic progress and college and career readiness throughout their high school career. The emphasis is on relationships, coaching, and facilitation and an agenda driven by student needs rather than subject matter conten t. Not a blanket advisory period for a group of students. 

# Additional Strategies: **To be asked if there is enough time in the survey**HSRS OMB Package 43

Cycle through Q 101 and Q 102 for each strategy the user selects in Q100.

**101. Is**  {service} **offered to all students (school -** **wide) or to a specific subset of**  students **? All students**  **(school -** **wide) Subset of** 

**students**
If user responds “Subset of students” to Q 101 , ask Q 102 **102. Please indicate which subset(s) of students are targeted for receiving**  { service} **.** Students with attendance issues (e.g., truancy, suspension, expulsion) Students performing below standards or grade level Students performing above standards or grade level Students in a particular grade level, regardless of performance Students recommended by high school staff (e.g., counselor or teacher) Re

- entry students English Language Learners Other (Please Specify________________)HSRS OMB Package 44



### Appendix **B :**  **Notification Letter**  **s and Fact Sheet**HSRS OMB Package 45

District Letter #1 (No research application) [Date] <SUPERINTENDENT NAME> Web Address: <DISTRICT NAME> Your STUDY ID: <XXXXXXX> <ADDR1> Your PASSWORD: <XXXXXXX>a <ADDR2> <CITY STATE ZIP> Dear <Superintendent>: We are writing to request your district’s participation in the High School Reform Study (HSRS). One or more schools in your district have been selected for this important national study to understand the strategies used by schools to prevent dropping out f rom school and to help students at risk for dropping out. The study is being conducted by SRI International and its partner RTI International on behalf of the U.S. Department of Education and its High School Graduation Initiative (HSGI). HSGI provides gran t funds to states and school districts in support of dropout prevention and reentry efforts. One school administrator from each sampled school will be asked to complete an online survey during fall 2014. HSRS will ask about the policies and strategies at each school and will take approximately 30 minutes for most respondents. The survey is designed to be completed by the school principal or a designee who is able to provide information about school policies and strategies. We are asking you to encourage the school(s) selected in your district to participate in HSRS. Participation is voluntary. All responses will be protected from disclosure. No schools or individuals will be identified by name. Data collected are used only for statistical purposes and ma y not be disclosed or used in identifiable form for any other purpose except as required by law (Public Law 107

- 279, Section 183). The data collected will be used in analyses to understand what services and supports are available through schools, what se rvices and supports are most prevalent across the country, and the nature of participation in these services and supports. Information collected from school administrators will help to inform and shape efforts to improve the quality of the high school expe rience, especially for those students at risk for not graduating high school. We plan to begin contacting selected schools in about a week. If your district has special research requirements, or if you have any questions about the study, please call XXX

-XXX

-XXXX . If you have questions about your rights as a study participant, you may call RTI’s Office for Research Protection in Durham, North Carolina, toll

-free at 1

-866

- 214

- 2043. We thank you in advance for your cooperation in this important research. S incerely,

Elizabeth Eisner Office of Planning, Evaluation and Policy Development U.S. Department of Education High School Graduation Initiative U.S. Department of Education Office of Elementary and Secondary Education U.S. Department of Education

Enclosure: HSRS Fact SheetHSRS OMB Package 46

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless su ch a collection displays a valid OMB control number. The vali d OMB control number for this information collection is xxxx
-xxxx. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving the interview, please write: U.S. Depa rtment of Education, Washington D.C. 20202
-4651. I f you have comments or concerns regarding the status of your individual interview, write directly to: H igh School Reform Study (HSRS), Office of Planning, Evaluation and Policy Development, 400 Maryland Ave, SW, Washington, DC 20202.HSRS OMB Package 47

District Letter #2 (With Research Application) [Date] <SUPERINTENDENT NAME> Web Address: <DISTRICT NAME> Your STUDY ID: <XXXXXXX> <ADDR1> Your PASSWORD: <XXXXXXX>a <ADDR2> <CITY STATE ZIP> Dear <Superintendent>: We are writing to request your district’s participation in the High School Reform Study (HSRS). One or more schools in your district have been selected for this important national study. HSRS seeks to understand the strategies used by schools to prevent dr opping out from school and to help students at risk for dropping out. The study is being conducted by SRI International and its partner RTI International on behalf of the U.S. Department of Education and its High School Graduation Initiative (HSGI). HSGI p rovides grant funds to states and school districts in support of dropout prevention and reentry efforts. One school administrator from each sampled school will be asked to complete an online survey during fall 2014. HSRS will ask about the policies and st rategies at each school and will take approximately 30 minutes for most respondents. The survey is designed to be completed by the school principal or a designee who is able to provide information about school policies and strategies. A research applicati on has been sent to your district’s research department. No contact will be made with the selected school(s) until we receive approval from the school district. Participation is voluntary. All responses will be protected from disclosure. No schools or indi viduals will be identified by name. Data collected are used only for statistical purposes and may not be disclosed or used in identifiable form for any other purpose except as required by law (Public Law 107

- 279, Section 183). The data collected will be u sed in analyses to understand what services and supports are available through schools, what services and supports are most prevalent across the country, and the nature of participation in these services and supports. Information collected from school admi nistrators will help to inform and shape efforts to improve the quality of the high school experience, especially for those students at risk for not graduating high school. We plan to begin contacting selected schools in about a week. If you have any questions about the study, please call XXX

XXX

-XXXX. If you have q uestions about your rights as a study participant, you may call RTI’s Office for Research Protection in Durham, North Carolina, toll

-free at 1

-866

- 214

- 2043. We thank you in advance for your coo peration in this important research. Sincerely,

Elizabeth Eisner Office of Planning, Evaluation and Policy Development U.S. Department of Education High School Graduation Initiative U.S. Department of Education Office of Elementary and Secondary Education U.S. Department of Education

Enclosure: HSRS Fact SheetHSRS OMB Package 48

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless su ch a collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx
-xxxx. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving the interview, please write: U.S. Depa rtment of E ducation, Washington D.C. 20202
-4651. If you have comments or concerns regarding the status of your individual interview, write directly to: H igh School Reform Study (HSRS), Office of Planning, Evaluation and Policy Development, 400 Maryland Ave, SW, Washington, DC 20202.HSRS OMB Package 49



### School Initial Contact Letter [Date] <SCHOOL ADMIN NAME> Web Address: <SCHOOL NAME> Your STUDY ID: <XXXXXXX> <ADDR1> Your PASSWORD: <XXXXXXX>a <ADDR2> <CITY STATE ZIP>
Dear <School Administrator>: You have been selected to participate in the High School Reform Study (HSRS). Thank you in advance for your school’s participation which is crucial to the success of this important research. HSRS seeks to understand the strategies used by high school s to help prevent students from dropping out. The study is being conducted by SRI International and its partner, RTI International, on behalf of the U.S. Department of Education and its High School Graduation Initiative (HSGI). HSGI provides grant funds to states and school districts in support of dropout prevention and reentry efforts. We ask you to complete a 30

- minute online survey about the policies and strategies at your school. The survey is designed to be completed by you or a staff person you desig nate who can provide information about school policies and strategies. Please use the web link, study ID and password provided above to access the survey. Your school district has been notified that we are contacting you about the study. All responses wil l be protected from disclosure. No individuals, other than research staff, will see any individually identifying data (for example, names or addresses). Data collected are only for statistical purposes and may not be disclosed or used in identifiable form for any other purpose except as required by law (Public Law 107

- 279, Section 183). Participation is voluntary. The data collected will be used in analyses to understand what services and supports are available through schools, what services and supports a re most prevalent across the country, and the nature of participation in these services and supports. Information collected from school administrators like you will help to inform and shape efforts to improve the quality of the high school experience, espe cially for those students at risk for not graduating high school. If you have any questions about the study, please call XXX

-XXX

-XXXX. If you have questions about your rights as a study participant, you may call RTI’s Office for Research Protection in Durham, North Carolina, toll

-free at 1

-866

- 214

- 2043. We thank you in advance for your cooperation in this important research. Sincerely,

Elizabeth Eisner Office of Planning, Evaluation and Policy Development U.S. Department of Education High School Graduation Initiative U.S. Department of Education Office of Elementary and Secondary Education U.S. Department of Education

Enclosure: HSRS Fact SheetHSRS OMB Package 50

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such a collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx
-xxxx. The time required to complete this information collectio n is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of th e time estimate or suggestions for improving the interview, please write: U.S. Department of Education, Washington D.C. 20202
-4651. If you have comments or concerns regarding the status of your individual interview, write directly to: H igh School Reform St udy (HSRS), Office of Planning, Evaluation and Policy Development, 400 Maryland Ave, SW, Washington, DC 20202.HSRS OMB Package 51



### School Reminder Letter #1 [Date] <SCHOOL ADMIN NAME> Web Address: <SCHOOL NAME> Your STUDY ID: <XXXXXXX> <ADDR1> Your PASSWORD: <XXXXXXX>a <ADDR2> <CITY STATE ZIP>
Dear <School Administrator>: We recently sent you a letter about participation in the High School Reform Study (HSRS). Thank you in advance for your school’s participation, which is crucial to the success of this important research. HSRS seeks to understand the strategies used by schools to prevent dropping out from school and to help students at risk for dropping out. The study is being conducted by SRI International and its partner RTI Intern ational on behalf of the U.S. Department of Education and its High School Graduation Initiative (HSGI). HSGI provides grant funds to states and school districts in support of dropout prevention and reentry efforts. Either you or a designee who is able to provide information about school policies and strategies may complete the 30

- minute survey. Please use the Web link, study ID, and password provided above to access the survey at your earliest convenience. Your school district has been notified that we are contacting you about the study. All responses will be protected from disclosure. No schools or individuals will be identified by name. Data collected are used only for statistical purposes and may not be disclosed or used in identifiable form for any othe r purpose except as required by law (Public Law 107

- 279, Section 183). Participation is voluntary. If you have any questions about your participation in the survey, please call XXX

-XXX

-XXXX . If you have questions about your rights as a study participant, you may call RTI’s Office for Research Protection in Durham, North Carolina, toll

-free at 1

-866

- 214

- 2043. We thank you in advance for your cooperation in this important research. Sincerely,

Elizabeth Eisner Office of Planning, Evaluation and Policy Development U.S. Department of Education High School Graduation Initiative U.S. Department of Education Office of Elementary and Secondary Education U.S. Department of Education

Enclosure: HSRS Fact SheetHSRS OMB Package 52

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless su ch a collection displays a valid OMB control number. The valid O MB control number for this information collection is xxxx
-xxxx. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving the interview, please write: U.S. Depa rtment of Education, Washington D.C. 20202
-4651. If you have comments or concerns regarding the status of your individual interview, write directly to: H igh School Reform Study (HSRS), Office of Planning, Evaluation and Policy Development, 400 Maryland Ave, SW, Washington, DC 20202.HSRS OMB Package 5 3



### School Reminder Letter #2 [Date] <SCHOOL ADMIN NAME> Web Address: <SCHOOL NAME> Your STUDY ID: <XXXXXXX> <ADDR1> Your PASSWORD: <XXXXXXX>a <ADDR2> <CITY STATE ZIP>
Dear <School Administrator>: Your school’s participation in the H igh S chool R eform S study is crucial to the success of this important research. Please consider completing an online 30

- minute survey about the policies and strategies at your school. If you would prefer, you may designate someone at your school to complete the survey on your behalf. To access the survey, use the Web link, study ID, and password provided above at your earliest convenience. The data collected will be used in analyses to understand what services and supports are available through schools, what serv ices and supports are most prevalent across the country, and the nature of participation in these services and supports. Information collected from school administrators will help to inform and shape efforts to improve the quality of the high school experi ence, especially for those students at risk for not graduating high school. The study is being conducted by SRI International and its partner RTI International on behalf of the U.S. Department of Education and its High School Graduation Initiative (HSGI). HSGI provides grant funds to states and school districts in support of dropout prevention and reentry efforts. Your school district has been notified that we are contacting you about the study. Participation is voluntary. All responses will be protected from disclosure. No schools or individuals will be identified by name. Data collected are used only for statistical purposes and may not be disclosed or used in identifiable form for any other purpose except as required by law (Public Law 107

- 279, Section 183). If you have any questions about your participation in the survey, please call XXX

-XXX

-XXXX. If you have questions about your rights as a study participant, you may call RTI’s Office for Research Protection in Durham, North Carolina, toll

-free at 1

-8 66

- 214

- 2043. We thank you in advance for your cooperation in this important research. Sincerely,

Elizabeth Eisner Office of Planning, Evaluation and Policy Development U.S. Department of Education High School Graduation Initiative U.S. De partment of Education Office of Elementary and Secondary Education U.S. Department of Education

Enclosure: HSRS Fact SheetHSRS OMB Package 54

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such a collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx
-xxxx. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for im proving the interview, please write: U.S. Department of Education, Washington D.C. 20202
-4651. If you have comments or concerns regarding the status of your individual interview, write directly to: H igh School Reform Study (HSRS), Office of Planning, Evaluation and Policy Development, 400 Maryland Ave, SW, Washington, DC 20202.HSRS OMB Package 55HSRS OMB Package 56



### Appendix C: Federal Register Notice